Basic Information
| Provider Information | |||||||||
| NPI: | 1073077384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | KAE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA, BCBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ORTH | ||||||||
| OtherFirstName: | ROBYN | ||||||||
| OtherMiddleName: | KAE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12650 HAMILTON CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460325400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172492242 | ||||||||
| FaxNumber: | 3176631175 | ||||||||
| Practice Location | |||||||||
| Address1: | 12650 HAMILTON CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460325400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172492242 | ||||||||
| FaxNumber: | 3176631175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2019 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.